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September 16, 1910 1286 

CALCUTTA— Cholera ana Plague. 

Acting Assistant Surgeon Allan reports, August 11: 

During the week ended July 23 there were 18 deaths from cholera 

and 17 from plague in Calcutta; in all Bengal, 31 cases of plague with 

31 deaths; in all India, 737 cases with bol deaths. 

ITALY. 

The Cholera Outbreak. 

Surg. H. D. Geddings at Naples reports, August 28, as follows: 

The announcement of the presence of cholera in Italy August 17 
came as a complete surprise. There had been no disturbing rumors, 
although the cholera situation in the Black Sea provinces of Russia had 
become disquieting and had led to renewed precautions in the handling 
of emigrants destined for the United States. On August 18 a circu- 
lar letter was addressed by this office to all steamship agencies in 
Naples announcing the enforcement of the quarantine regulations of 
the United States in regard to cholera. During the afternoon of 
August 17 and the morning of August 18 about 80 passengers of the 
steerage class were placed under observation in a special boarding 
house designated by the Italian inspector of emigration at this port. 

Origin of the infection. — Reliable information gives the cause of 
the outbreak as the debarkation at Brindisi of a party of Russian 
gypsies from Batum, who proceeded by rail to Trani, which is to be 
regarded as the primary focus of the epidemic. Whether any of the 
wanderers were ill upon arrival admits of doubt; but it is certain that 
arriving in Trani they washed clothing in vessels used for drawing 
water from a well, and in due course there followed cases of choleri- 
form disease, the nature of which was not immediately recognized, 
and which were regarded by the authorities as "grave gastro-intestinal 
disturbances." The infection spread to various towns and cities in the 
provinces of Bari and Foggia, both in the region of Apulia. 

The town of Trani has up to this time suffered most severely, and 
it is to be regarded as the primary focus of infection, the outbreak 
partaking of the characteristics of a water-borne epidemic. The 
infection at other points is secondary, and the nature of the spread 
ap to this time points to "contact" outbreaks. 

Extent of the infection. — To this time the disease has made its 
appearance in the following places: In the province of Bari, at Andria, 
Trani, Corato, Bitonto, Spinazzola, Barletta, Bari, and Bisceglie. In 
the province of Foggia, at Cerignola, Trinitapoli, San E'erdinando di 
Puglia, and Margherita di Savoia. The province of Lecce at this date 
remains free from infection, and it is to be remembered that these 
three provinces compose the region or district of Apulia. 

The following figures represent as nearly as can be arrived at the 
incidence and mortality up to and including August 20: 



Cases. 


Deaths. 


SO 


33 


16 


10 


9 


8 


1 


1 


2 


2 


1 


1 


1 





Trani 

Barletta 

Andrea 

Bitonto 

Bisceglie... 
Spinazzola . 
"Sari 



1287 September 16, 1910 

The statistical information from the other points is not at this date 
available, but the number of cases and deaths is small. 

Measures taken by the authorities. — Inspectors and commissioners were 
promptly sent from the central sanitary office at Rome to the infected 
district and the measures taken by them have been thorough and seem 
to have had good results. The situation to-day is considerably im- 
proved. Travel in the infected district is being restricted and regu- 
lated; towns are being cleaned and put in better sanitary condition, 
and arrangements have been made for the distribution of drinking 
water from the aqueduct of Ofanto, a source of great purit}^. Bari 
will receive 150 cubic meters daily, and Barletti, Trani, and Bisceglie, 
each about 100 cubic meters. Prohibitions have already been put in 
force as to the sale of fruits, especially melons, tomatoes, cucumbers, 
and other articles of food, such as snails, oysters, and mussels. The 
exportation of fruits, vegetables, etc., from the infected districts has 
also been prohibited. Hospitals have been organized in all towns, and 
large quantities of disinfectants have been distributed, while all doubt- 
ful wells have been closed, and all suspected cisterns have been ordered 
cleaned and refilled with the pure water mentioned above. Special 
precautions have also been taken at all the ports which have Russian 
connections. 

Conditions in Naples. — Naturally there is some uneasiness in Naples, 
and the sanitary authorities have been spurred to great activity. 
With the careful regulation of railroad travel much of the risk to 
Naples will be removed. The water supply of the city is such, and 
its source is so removed from all human habitation, and so carefully 
policed and guarded, that a water-borne epidemic of cholera is, 
humanly speaking, impossible. But should cases be introduced into 
the lower quarters of the city, there would undoubtedly be contact 
epidemics or at least outbreaks. Sanitary matters are receiving the 
careful consideration of the proper authorities, and there is no sense of 
false security with its attendant danger. 

The relation of the outbreak to emigration. — This aspect of the sub- 
ject is the one of the most importance to the sanitary authorities of 
the United States, and I am glad to be able to report a satisfactory 
condition of affairs. As previously mentioned, detention of persons 
and the disinfection of their baggage and effects was begun coinci- 
dently with the first alarm. The Italian commissioner-general of emi- 
gration came at once to Naples, and with him and the representatives 
of the various steamship companies arrangements have been com- 
pleted as follows: 

I. Pending the inauguration of measures to be hereafter detailed 
the movement of emigration from the infected provinces to Naples by 
rail will be prohibited. 

II. As soon as the necessary arrangements can be made, all would- 
be emigrants from the infected provinces will be collected in a clean 
town, under proper sanitary regulations, and brought to Naples on 
special trains, which trains will be under the supervision of military 
medical officers, and the trains will be equipped with all necessary 
emergency supplies and provided with a sufficient force of military 
hospital stewards and nurses. 

III. Arriving in Naples, the emigrants will be carried from a special 
station, on special tenders or lighters, to a hospital or receiving ship 
which will be moored off the end of the mole. This ship will be 



September 16, 1910 



1288 



capable of receiving 400 or more emigrants, will have some bathing 
facilities, a sulphur furnace, facilities for the disinfection of the cloth- 
ing in which the emigrants arrive, special arrangements for the disin- 
fection of all excreta prior to discharge into the waters of the bay, a 
clinical laboratory for diagnostic use, and in addition to the regular 
complement will have on duty a naval medical officer and a force of 
naval stewards and nurses, and to this ship Acting Assistant Surgeon 
Buonocore and 1 will have access at all times. Under these condi- 
tions the emigrants will be detained five full days, and then brought 
to the regular place of embarkation for the medical examination. 
The present shore facilities for the disinfection of personal effects are 
ample and are under our control. Should any case of cholera mate 
its appearance on the receiving ship, the ship, with all on board, will 
at once put to sea and repair to the quarantine station on the Island 
of Sardinia and her place will be taken by another ship. The vessel 
will be ready for the reception of passengers August 29. 
Doctor Geddings further reports, August 29: 

Status of Cnolera In Italy during tne Weak ended August 27. 



Deaths. 



Province of Bari: 

Andria 

Barletta 

Bitonto 

Canosa 

Grumo Appula 

Molfetta 

Euvo 

Spinazzola 

Trani 

Province of Foggia: 

Cerignola 

San Ferdinando 

Margherila di Savoia 

Ortanova 

Trinitapoli 

Province of P tenza: 

Genzano 

Palazzo San Gervasio 



IS 


9 


68 


46 


1 





6 


2 


1 





2 





3 


1 


6 


2 


33 


29 


8 


2 


1 


3 


9 


7 


1 





16 


5 


■?, 


1 


1 


1 



Genzano and Palazzo San Gervaso are in the district of the Province 
of Potenza which adjoins the Province of Bari.